Mindfulness-Based Cognitive Therapy to reduce stress for family carers of relatives living with dementia- an intervention study

Mindfulness-Based Cognitive Therapy (MBCT) This is a non-drug intervention which uses teaching of cognitive skills to reduce mental distress. A pack of written materials will be used by the instructor, and another pack of written materials will be given to the participants. The pack of written materials used by the instructor is to ensure fidelity and have been specifically designed for this study. The resources for the participants are designed to be home reading and support for home practice. Some of these will be taken from the guilford publications website (https://www.guilford.com/segal2-forms) which are a resource available to all purchasers of the MBCT instruction manual, Mindfulness-Based Cognitive Therapy for Depression, Second edition by Segal, Williams and Teasdale. The rest of the participant resource pack will be materials specifically designed for this study. There are 8 sessions, each lasting 2.5 hours, delivered weekly consisting of activities such as guided meditation practices, group and pair discussions, written exercises and home practice. The home practice will involve brief readings as well as formal and informal practices. The readings will usually be summaries of the sessions to consolidate new knowledge as well as instructions for practices. In some weeks there will be written exercises to complete. In all weeks there will be an invitation to do a guided practice for about 30 minutes using a drop box link to an audio file recorded specifically by the lead researcher for this study. Alternatively, participants will be able to use a CD or a website link to guilford.com for standard MBCT audio-files if they don't wish to use drop box. The duration of all home practice will be upto 45 min per day for 6 out of 7 days of the week but it is not a requirement of the study that this amount of practice is adhered to. Every week participants will fill out a home practice record to monitor the amount of home practice being done. We will also encourage adherence by exploring barriers to practice at each session. There will be an optional follow up booster session 3 months after the intervention. One of the practices will involve eating a raisin. There will be some movement based practices as well. They will be run in person. Zoom will be an option for carers who cannot attend in person, or if there is a pandemic related lockdown/social restriction. We will provide zoom training for any participants who wish to have this. They will be delivered by the lead researcher who is an experienced psychiatrist, trained in MBCT, and with a year of experience. They will be supervised by a more experienced MBCT trainer. There will also be a co-facilitator to assist who will have a background in health care, and training to manage any distress experienced by participants. The location for the intervention will be a community venue. The intervention is planned to be personalised a little to individuals, and adaptations may happen for the entire group. There will be an intake interview where personal details of each participant are collected to assess suitability and need to tailoring of the intervention. This is particularly around the area of trauma histories where the MBCT instructor/lead researcher needs to be aware any potential for distress that may be incurred by elements of the MBCT intervention. If significant trauma histories are gathered for individual participants, the MBCT instructor will be careful to check the progress of these participants and be vigilant for any distress that may be triggered. There may also be adaptations of the MBCT for the entire group depending on how the group experiences the MBCT. This is because MBCT has never been delivered for family carers of people with dementia in NZ before, and therefore they may be adaptations that are necessary as we go along. The MBCT instructor will be receiving supervision weekly from a highly trained MBCT supervisor, and will be making any necessary adjustments to the intervention for individuals and the group in consultation with this person, and documenting these carefully. Intervention fidelity will be assessed by getting an independent researcher (with expertise in MBCT) to check the elements of the MBCT programme on a fidelity checklist against an audio-recording of each MBCT session. This will be done weekly as the intervention progresses. If any elements are not covered, then this researcher will notify the MBCT instructor who will make sure they cover it in the next session. The size of the group will be 15 participants. There will also be 1 psychiatrist, 1 co-facililator and possibly 1-2 other members of the research team to help with set up and research tasks.